4: ENT pathology Flashcards
What lines the ear canal?
Epidermis (stratified squamous epithelium)
What are ceruminous glands?
Produce earwax
Any pathology which affects the ___ can also affect the ear canal.
Skin
What kind of epithelium lines the middle ear?
Columnar epithelium
What is the Organ of Corti?
Part of cochlea which contains hair cells
What type of epithelium is found in the nasal vestibule?
Keratinised squamous epithelium
What type of epithelium is found in the nasal cavities and sinuses?
What is it exactly the same as?
Schneiderian epithelium
Respiratory epithelium - pseudostratified ciliated columnar epithelium with goblet cells
What types of epithelium are found in the throat?
Respiratory epithelium
Squamous epithelium for vocal cords
What type of glands are the salivary glands?
Exocrine glands
What do the serous cells and mucus cells of the salivary glands secrete?
Serous - digestive enzymes e.g alpha amylase
Mucus - clear grey sticky mucus
What is otitis media?
Inflammation of the middle ear
What usually causes otitis media?
Viruses
Occasionally bacteria, if chronic, suspect Pseudomonas
What is a cholesteatoma?
NOT a TUMOUR and DOESN’T CONTAIN CHOLESTEROL
Production of keratinised squamous epithelium in middle ear producing nasty discharge
Cholesteatoma involves the metaplasia of ___ ___ epithelium into ___ ___ epithelium.
cuboidal glandular
squamous keratinised
What is a nerve tumour of the nerve which controls balance?
Vestibular schwannoma
Tumours at which angle are almost always benign vestibular schwannomas?
Cerebellopontine angle
What do schwannomas look like on histology?
Elongated nuclei
Verocay bodies - sandwiches of cells between darker palisades
What genetic disease predisposes you to bilateral schwannomas?
Neurofibromatosis type 2
(also cafe au lait spots, axillary freckles, Lisch nodules in the eye)
What sign is seen in the eyes in neurofibromatosis type 2?
Lisch nodules
What is the mode of inheritance of NF type 2?
Autosomal dominant
What are common benign masses found in the nose?
Which group are they NOT common in?
Nasal polyps
Children
If you encounter a child with nasal polyps, what should you consider?
Cystic fibrosis
Are nasal polyps painful?
No
What type of vasculitis has a lot of midline symptoms (i.e ENT, renal)?
Wegener’s granulomatosis
Now called granulomatosis with polyangiitis
Which antibodies are detected in
a) microscopic polyangiitis
b) granulomatosis with polyangiitis (Wegener’s)?
a) pANCA
b) cANCA
What is one of the most common reasons for nasal ulceration?
Cocaine
What happens to blood vessels in granulomatosis with polyangiitis?
Occluded by giant inflammatory cells
What are some benign tumours of the nasal cavity?
Squamous cell papillomas
Schneiderian papillomas
What are some malignant lesions of the nasal cavity?
Squamous cell carcinoma
What are malignant tumours of glandular epithelium?
Adenocarcinoma
What is a rare malignant tumour of the nasopharynx?
What virus is strongly associated with it?
Nasopharyngeal carcinoma
Epstein-Barr virus
Which virus is associated with blood cancers and epithelial malignancy?
EBV
remember EBV causes glandular fever (which can result in lymphoma) and nasopharyngeal carcinoma
Which part of the cell cycle does EBV trigger?
Transition from G0 to G1, starts growth
What are benign tumours of the vocal cords which form in response to smoking, trauma and inflammation?
Laryngeal polyps
What ulcer is an inflammatory response to trauma of the vocal cords?
Contact ulcer
What benign tumour forms in the larynx and is associated with a virus?
Which specific strains of the virus?
Squamous cell papilloma
HPV types 6 and 11
What do papillomas look like?
Finger-like projections
“papillomatous”
What are paraganglioma?
Tumours arising from neuroendocrine cells
Which types of paraganglioma are found
a) above the diaphragm
b) below the diaphragm?
Chromaffin negative - don’t secrete catecholamines, major blood vessels, head and neck
Chromaffin positive - your phaechromocytoma type tumours which secrete catecholamines
What genetic disease are numerous phaeochromocytomas a feature of?
What is its mode of inheritance?
MEN2
Autosomal dominant
What is the most common malignant tumour of the head and neck?
Squamous cell carcinoma
What are the lifestyle factors commonly associated with squamous cell carcinoma?
Smoking
Alcohol
Which type of HPV is associated with squamous cell carcinoma?
Type 16
(remember 6 and 11 are the papilloma ones)
What pathways does type 16 HPV disrupt?
p53
Rb
How is squamous cell carcinoma of the head and neck treated?
Radiotherapy
Chemotherapy
What staging system is used for head and neck tumours?
TNM staging
Which salivary gland is the most common for tumours?
Parotid glands
Tumours in the (parotid / smaller) salivary glands are more likely to be malignant.
smaller glands
What is a massive red flag for malignant tumours of the salivary glands?
Pain
means CN VII has been infiltrated
What is the most common tumour of salivary glands?
Pleomorphic ADENOMA
(remember glandular)
Where are pleomorphic adenomas usually found?
How are they treated?
Parotid glands
Excised due to risk of malignant transformation
Pleomorphic adenoma is more common in (males / females) of which age?
Females
Older ( > 60)
What is the second most common benign tumour of the parotid gland?
Warthin’s tumour
What should make you suspicious of a malignant salivary gland tumour?
Painful
Lump in the neck
Warthin’s tumour of the parotids is more common in (males / females) of which age?
What lifestyle choice are they associated with?
Are they unilateral or bilateral?
Men
Smoking
Bilateral
